What Would Hippocrates Do?

By TARA PARKER-POPE
Lately, I’ve been reading a fascinating new book, “Hippocrates’ Shadow: Secrets From the House of Medicine” (Simon & Schuster, 2008), which explores the entrenched subculture of doctors and medical practice.

The author, Dr. David H. Newman, is an emergency medicine physician at St. Luke’s-Roosevelt Hospital Center in New York who was also deployed in Iraq in 2005. The book focuses on the missteps of modern medicine, but it begins with a fascinating look back at where it all began. Here is an excerpt.

By David H. Newman, M.D.

By today’s standards, Hippocrates was a profoundly abnormal physician.

Medicine’s founding father routinely tasted his patients’ urine, sampled their pus and earwax, and smelled and scrutinized their stool. He assessed the stickiness of their sweat and examined their blood, their phlegm, their tears, and their vomit.

He became closely ac quainted with their general disposition, family, and home, and he studied their facial expressions.

In deciding upon a final diagnosis and treatment, Hippocrates recorded and considered dietary habits, the season, the local prevailing winds, the water supply at the patient’s residence, and the direction the home faced.

Modern-day physicians often cringe or shake their heads when they hear descriptions of Hippocrates’ diagnostic methods; laypeople, however, have quite a different response — they wonder aloud at how nice it might be to have Hippocrates as their doctor.

Somewhere in our twenty-four-hundred-year journey from the island of Cos in ancient Greece to the modern centers of the technologically and scientifically advanced medicine that we now practice, the interests and the goals of patients and doctors have gone their separate ways.

Most likely it was at first a subtle divergence, and the chosen road was undoubtedly paved with noble intentions. But no matter how it started, we physicians have steadily moved in a different direction than our patients, and now we are light-years apart.

In 400 b.c., when Hippocrates led the medical academy at Cos, documenting his patient encounters, teaching his students the Art of medicine (he capitalized the A), and writing what would become known as the Hippocratic Corpus, he was unaware that he was establishing Western medical theory for the next two-plus millennia.

But while today’s physicians take a lifetime oath adapted directly from his writings,Hippocrates wouldn’t recognize our interpretation of the Art.

Hippocrates was a holistic practitioner intent on treating the complete person, whereas today we tend to specialize in exquisitely narrow fields of anatomic and physiologic knowledge, leaving the balance of the human body to our colleagues.

Hippocrates was a devoted and objective empiricist, while most modern doctors spend so little time with each patient that it’s absurd to claim serious observational skills.

In his teachings to neophyte practitioners and students, Hippocrates cautioned physicians to “make no pretense to infallibility.” As one might expect of a physician practicing in an age before the accurate elucidation of human function and disease, he was acutely aware of his lack of knowledge.

Given this lack, his success as a physician and a physician-educator is mystifying.

Despite subscribing to the “humors” theory of human health, despite knowing neither the location nor the function of the human heart, and despite being unaware of staple concepts like oxygen or the passage of blood through arteries and veins, Hippocrates was heralded as a man of medical science whom his patients and students loved, and whom the Western world lionized.

How can someone with little to no true scientific knowledge still be seen as the great master of medical science?

There’s a linguistic clue that may help to explain how a prescientific Hippocrates flourished in, and eventually led, the field of medicine. Those who’ve attempted to translate the Hippocratic writings for modern readers have often noted an idiosyncrasy in the language: the ancient Greeks made no distinction between “art” and “science.”

In Hippocrates, translator W. H. S. Jones notes in an introductory passage, “The word ‘tešcnh’ can mean either ‘art’ or ’science,’ though it inclines more towards the former.” Discussing the evolution of ancient Greek language, he continues, “We have to wait until Aristotle . . . before there is a word approximately equivalent to our ’science’ without any additional notion of ‘art.’ ”

Hippocrates and his contemporaries believed the worlds of poetry, music, and medicine to be fundamentally intertwined. For ancient Greeks the scientist was philosopher and vice versa, as they envisioned their disciplines in a vastly different way than we envision our scientific models of thought and knowledge today.

Hippocrates did not see the field of medicine as a storage bin of ultimately knowable facts and figures, and therefore he neither pretended nor aspired to be all-knowing. Instead, he knew his patients.

That doctors often don’t have the answers they and their patients seek is a medical secret, the symptom of a quiet and pervasive deception. Physicians are frequently portrayed in popular media as all-knowing, and are often looked to for answers or expertise far beyond the reaches of our limited science and our narrow training.

And yet a physician friend once told me that he learned during medical school that there are two things a doctor never says: “I don’t know” and “I was wrong.” That is a decidedly un-Hippocratic lesson.

Physicians are only, after all, consultants to the health of others. What we offer is our consultation and our limited expertise, in the hope that we can collaborate, that we can build a partnership. I tell friends that when a doctor says, “I don’t know,” it is rarely a sign of weakness or ignorance.

More often it’s a sign of a physician who knows and appreciates the limits of our science and is willing to be a partner. It’s an olive branch of commiseration about what is not, and a hopeful readiness for what is.

I consider myself very lucky when I find a doctor who actually has the guts to tell me he doesn't know what's wrong with me but that he'll try his best to find out, and, in the meantime, at least attempt to make me feel better.